Ophthalmology

Ophthalmology: Lecture Notes

Contents

Preface to Twelfth Edition

Preface to First Edition

Acknowledgements

Abbreviations

About the Companion Website

1: Anatomy

Introduction

Surface Anatomy of the Face

Sensory Innervation of the Face: the Fifth Cranial Nerve

Gross Anatomy of the Eye

The Orbit

The Eyelids (The Tarsus)

The Lacrimal Drainage System

Detailed Functional Anatomy

The Tear Film

The Cornea

The Sclera

The Choroid

The Retina

The Vitreous

The Ciliary Body

The Iris

The Iridocorneal (Drainage) Angle

The Lens

The Optic Nerve

The Ocular Blood Supply

The Third, Fourth and Sixth Cranial Nerves

Central Origin

Peripheral Course

Assessment Questions True or False

Answers

2: History, Symptoms and Examination

Introduction

General Ophthalmic History

Specific Ophthalmic History

Red Eye

Sudden Visual Loss

Gradual Visual Loss

Ocular Pain

Diplopia

Examination

Physiological Testing of the Eye

Visual Fields

Colour Vision

Pupillary Reactions

Eye Movements

Anatomical Examination of the Eye

Special Examination Techniques

Investigative Techniques

Assessment Questions True or False

Answers

3: Clinical Optics

Introduction

Refractive Error (Ametropia)

Accommodation and Presbyopia

Optical Correction After Cataract Extraction

Contact Lenses

Spectacles

Low-Vision Aids

Refractive Surgery

Assessment Questions True or False

Answers

4: The Orbit

Introduction

Clinical Features

Proptosis

Enophthalmos

Pain

Eyelid and Conjunctival Changes

Binocular Diplopia

Visual Acuity

Investigation of Orbital Disease

Differential Diagnosis of Orbital Disease

Disorders of the Extraocular Muscles

Infective Disorders

Inflammatory Disease

Vascular Abnormalities

Orbital Tumours

Dermoid Cysts

Assessment Questions True or False

Answers

5: The Eyelids

Introduction

Abnormalities of Lid Position

Ptosis

Entropion

Ectropion

Inflammation of the Eyelids

Blepharitis

Benign Lid Lumps and Bumps

Chalazion

Molluscum Contagiosum

Cysts

Squamous Cell Papilloma

Xanthelasmas

Keratoacanthoma

Naevus (Mole)

Malignant Tumours

Basal Cell Carcinoma (BCC)

Squamous Cell Carcinoma

Abnormalities of the Lashes

Trichiasis

Assessment Questions True or False

Answers

6: The Lacrimal System

Introduction

Abnormalities in Tear Flow and Evaporation – Dry Eye

Aqueous-Deficient Dry Eye

Evaporative Dry Eye – Inadequate Meibomian Oil Delivery

Evaporative Dry Eye – Malposition of the Globe or Lid Margins

Cicatricial Conjunctival Disorders

Disorders of Tear Drainage

Obstruction of Tear Drainage (Infantile)

Obstruction of Tear Drainage (Adult)

Infections of the Nasolacrimal System

Assessment Questions True or False

Answers

7: Conjunctiva, Cornea and Sclera

Introduction

Symptoms

Signs

Conjunctiva

Inflammatory Diseases of the Conjunctiva

Conjunctival Degenerations

Cornea

Infective Corneal Lesions

Corneal Dystrophies

Disorders of Shape

Corneal Degenerations

Corneal Thinning

Corneal Grafting

Sclera

Assessment Questions True or False

Answers

8: The Lens and Cataract

Introduction

Cataract

Definition and Causes

Symptoms

Signs

Investigation

Treatment

Congenital Cataract

Disorders of Lens Shape

Disorders of Lens Position (Ectopia Lentis)

Assessment Questions to Check Your Understanding

Answers

9: Uveitis

Introduction

Epidemiology

Specific Conditions Associated With Uveitis

Ankylosing Spondylitis

Reiter's Disease

Juvenile Idiopathic Arthritis-Related Uveitis

History

Fuchs' Heterochromic Uveitis

Toxoplasmosis

Behçet's and Vogt–Koyanagi–Harada Diseases

AIDS and CMV Retinitis

Sympathetic Ophthalmitis

Assessment Questions True or False

Answers

10: Glaucoma

Introduction

Pathophysiology

Classification

Pathogenesis

Primary (Chronic) Open-Angle Glaucoma

Closed-Angle Glaucoma

Secondary Glaucoma

Congenital Glaucoma

Chronic (Primary) Open-Angle Glaucoma

Epidemiology

Genetics

History

Examination

Treatment

Normal-Tension Glaucoma

Primary Angle-Closure Glaucoma

Epidemiology

History

Examination

Treatment

Secondary Glaucoma

Congenital Glaucoma

Prognosis of the Glaucomas

Assessment Questions True or False

Answers

11: Retina and Choroid

Introduction

Symptoms of Retinal Disease

Macular Dysfunction

Peripheral Retinal Dysfunction

Acquired Macular Disease

Age-Related Macular Degeneration

Macular Holes and Membranes

Central Serous Retinopathy

Macular Oedema

Toxic Maculopathies

Vitreous Floaters and Posterior Vitreous Detachment

Retinal Detachment

Rhegmatogenous Retinal Detachment

Traction Retinal Detachment

Retinoschisis

Inherited Retinal and Photoreceptor Dystrophies

Retinitis Pigmentosa

Cone Dystrophy

Juvenile Macular Dystrophies

Albinism

Retinal Tumours

Retinoblastoma

Astrocytomas

Choroidal Lesions, Including Melanoma

Metastatic Tumours

Assessment Questions

Answers

12: Retinal Vascular Disease

Introduction

Signs of Retinal Vascular Disease

Leakage from the Microcirculation

Occlusion of the Microcirculation

Diabetic Retinopathy

Arterial Occlusion

Venous Occlusion

Arteriosclerosis and Hypertension

Retinopathy of Prematurity

Sickle-Cell Retinopathy

Abnormal Retinal Blood Vessels

Abnormalities of the Blood

Assessment Questions

Answers

13: The Pupil and Its Responses

Introduction

Ocular Causes of Pupillary Abnormality

Neurological Causes of an Abnormal Pupil

Horner's Syndrome

Relative Afferent Pupillary Defect (RAPD)

Light-Near Dissociation

Adie's Tonic Pupil

Argyll Robertson Pupil

Midbrain Pupil

Other Causes of Pupillary Abnormality

Assessment Questions True or False

Answers

14: Disorders of the Visual Pathway

Introduction

The Optic Nerve

The Swollen Optic Disc

Papilloedema Due to Raised Intracranial Pressure

Optic Neuritis

Ischaemic Optic Neuropathy

Optic Atrophy

The Chiasm

Optic Tract, Radiation and Visual Cortex

Assessment Questions

Answers

15: Eye Movements and their Disorders

Introduction

Anatomy and Physiology

Non-Paralytic Squint

Binocular Single Vision

Aetiology of Non-Paralytic (Concomitant) Squint

Paralytic Squint

Isolated Nerve Palsy

Disease of the Extraocular Muscles

Dysthyroid Eye Disease (Grave's Disease)

Myasthenia Gravis

Ocular Myositis

Chronic Progressive External Ophthalmoplegia (CPEO)

Brown's Syndrome

Duane's Syndrome

Gaze Palsies

Lesions of the Parapontine Reticular Formation (PPRF)

Internuclear Ophthalmoplegia

Parinaud's Syndrome (Dorsal Midbrain Syndrome)

Abnormal Oscillations of the Eyes

Nystagmus

Assessment Questions

Answers

16: Trauma

Introduction

History, Symptoms and Signs

Examination

Without a Slit Lamp

With a Slit Lamp

Treatment

Orbital Blow-Out Fracture

Lacerations to the Skin and Lids

Corneal Abrasions

UV Injury to the Cornea

Corneal Foreign Bodies

Corneal and Scleral Penetrating Trauma

Uveitis

Hyphaema

Retinal Damage

Chemical Injury

Prognosis

Assessment Questions True or False

Answers

17: Tropical Ophthalmology: Eye Diseases in the Developing World

Introduction

Reasons for the Greater Prevalence of Blindness in the Developing World

Providing Eye Care in the Developing World

Major Causes of Blindness

Blindness in Childhood

Causes of Adult Blindness

Cataract

Tropical Diseases

Trachoma

Onchocerciasis (River Blindness)

Vitamin A Deficiency (Xerophthalmia)

Measles

Corneal Infection, Ulceration and Scarring

HIV and AIDS

Ophthalmia Neonatorum

Diabetic Retinopathy

Assessment Questions True or False

Answers

References

18: Eye Diseases in Children

Introduction

Developmental Anatomy and Embryology

Development of Vision/Visual Milestones

Delayed Visual Maturation (DVM)

History and Examination

Assessment of Visual Acuity

Testing the Visual Field

Testing Binocular Vision

External Examination

Direct Ophthalmoscopy

Refraction and the Role of the Optician/Optometrist (General Ophthalmic Services)

Fundus Examination

Summary of Ocular Disease Seen in Children

The Orbit

The Eyelids

The Lacrimal System

Conjunctiva, Cornea, Sclera

Cataract

Uveitis

Glaucoma

Retinal and Choroidal Disease

Prematurity and the Eye

The Visual Pathway

Eye Movement Disorders

Squint

Nystagmus

Trauma

Child Abuse

Assessment Questions True or False

19: Services for the Visually Handicapped

Visual Impairment

Key Facts

Definitions

The Causes of Visual Impairment

Effect of Vision Impairment on Motor Function, Social Interactions and Cognition

Colour Blindness – Impact on Learning and Choice of Career

Rehabilitation of an Individual with Vision Impairment

Living Skills

Schools for the Visually Impaired

Low Vision Aids

Guide Dogs

White Cane

Certification, Statement of Educational Needs

Useful Contacts and Agencies

20: Clinical Cases

Introduction

Clinical Cases

Case 1

Case 2

Case 3

Case 4

Case 5

Case 6

Case 7

Case 8

Case 9

Case 10

Case 11

Case 12

Case 13

Case 14

Case 15

Case 16

Case 17

Case 18

Case 19

Case 20

Case 21

Case 22

Case 23

Case 24

Case 25

Useful References

Textbooks

Clinical Ophthalmology

Basic Science

Review Journals

Ophthalmic Journals

Websites

Organizations Producing Patient Information Literature

Appendix 1: Conversion Table for Representation of Visual Acuity

Appendix 2: Drugs Available for Ophthalmic Use

Treatment of Infection

Topical Antibiotics

Treatment of Chlymidial Infections

Treatment of Acanthamoeba Infections

Treatment of Viral Infections

Treatment of Fungal Infections

Treatment of Inflammation

Non-Steroidal Anti-Inflammatory Preparations

Steroid Preparations

Mast Cell Stabilizers

Antihistamines

Mucolytics

Mydriatics and Cycloplegics

Antimuscarinics

Sympathomimetics

Ocular Hypotensives

Beta Receptor Antagonists

Prostaglandin Analogues

Sympathomimetics

Carbonic Anhydrase Inhibitors

Miotics

Local Anaesthetics

Ocular Lubricants

Vascular Endothelial Growth Factor Inhibitors

Diagnostic Preparations

Index

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